Systematic Review of Selective Decontamination of Digestive Tract for the Prevention of Hospital Infection in Intensive Care Unit

Abstract：Objective:To systematically review the efficacy and safety of selective decontamination of digestive tract(SDD)for preventing hospital infection in intensive care unit(ICU).Method:According to principles of Evidence Based Medicine(EBM),we searched PubMed(1995-2012), EMBASE(1995-2012),Cochrane Library(Issue 3,2012),Chinese Biomedical Literature Database (CBMdisc)(1995-2012),China National Knowledge Infrastructure (CNKI)(1995-2012),VIP database(1995-2012),and hand searched several related Chinese journals in the past ten years.Two reviewers independently screened the studies for eligibility,extracted data and evaluated their methodological quality.The titles and abstracts of every record retrieved were firstly scanned to determine which were possibly relevant to our review.Any record that appeared likely to meet the inclusion criteria was obtained in full text.Differences in opinion between reviewers were resolved by discussion or decided by the third party.The methodological quality of the included trials such as randomization,allocation concealment,blind and following-up was assessed.Meta-analysis was performed by using RevMan 4.2 software. Result:A total of 5738 studies were identified by both electronic and hand searches.After the process of quality assessment,9 randomized control trails including 13 685 patients,which met our inclusion criteria,were included. All the nine included studies mentioned the randomization procedure,but no allocation concealment was described.6 studies carried out blind in each step,so we considered each of the 6 studies was at moderate risk of different biases and graded as category“B”.While 3 other studies used no blind at all,so we considered each of the 3 studies was at high risk of different biases and graded as category“C”.Based on Meta-analysis,the mortality rate (treatment group versus control group) were 23.3%,25.2%,respectively,RR 0.93,95%CI(0.86,0.99)(P<0.05).The lower respiratory tract infection rate(treatment group versus control group) were 29.5%,45.9%,respectively, RR 0.64,95%CI(0.54,0.76)(P<0.0001).The bloodstream infection rate (treatment group versus control group) were 5.7%,10.8%,respectively,RR 0.63,95%CI(0.49,0.82)(P<0.001).The urinary tract infection rate(treatment group versus control group) were 9.4%,15.5%,respectively,RR 0.60, 95%CI(0.41,0.87)(P<0.01).In addition,no data regarding ICU patients’adverse events associated with SDD were reported.Conclusion:Compared with placebo,SDD could effectively and safely reduce the mortality rate and hospital infection rate of ICU patients.